Food Faddism Complicating Jaundice in Gilbert’s Syndrome Patients- A Prospective Cohort Study

Abstract

Introduction: Food faddism is a term that refers to a particular food or food group that is overemphasised in the regular diet or omitted to cure a specific condition. It affects an individual’s health by complicating the health status of already infected individuals, which harms their nutritional status in particular, causing macro and micronutrient deficiencies. In the present study, authors have analysed the effect of food faddism in Gilbert’s syndrome patients. The state of vitamin B12 deficiency (Megaloblastic anaemia) is observed because of dietary restrictions due to food myths causing ineffective erythropoiesis prolonging hyperbilirubinemia in Gilbert’s syndrome patients. Aim: To study the effect of food faddism on haematological parameters in recently diagnosed Gilbert’s syndrome patients. Materials and Methods: A prospective cohort study was conducted in a tertiary care centre of north coastal Andhra Pradesh, India, from June 2019 to June 2021. A total of 125 consecutive patients, newly-diagnosed with Gilbert’s syndrome, were enrolled. A constant rise in the indirect bilirubin levels between 2-5 mg/dL with normal serum liver transaminases was considered for diagnosing Gilbert’s syndrome. On monthly follow-up for six months, 21 patients presented with extreme fatigue and limb paraesthesia. Every month during the follow-up, thorough history about any recent changes in food habits was noted. Blood investigations like complete blood pictures and Vitamin B12 levels were done at the time of diagnosis, after six-month follow-up, and after treatment with co-methyl (Cyanocobalamin) B12 injections. Comparison of study variables at the time of diagnosis of Gilbert’s syndrome, before and after the treatment with co-methyl (Cyanocobalamin) B12 injections was done using paired t-test based on nature of distribution, and p-value was calculated. Results: Out of 125 Gilbert’s syndrome patients with a mean age distribution of 36.15±11.82 in (109) males and 36.06±11.93 in (16) females, 21 patients presented with symptoms after six months of follow-up, a habit of practicing a fad diet was noted, along with depression of cell lines showing pancytopenia. There was a significant decrease in the mean values of Haemoglobin (Hb)% (12.68 to 7.95), Total Count (TC) (8219.05 to 3819 cells/cumm), Mean Corpuscular Haemoglobin Concentration (MCHC) (33.30 to 32.17) and Vitamin B12 (391.63 to 125.68) and increase in mean value of Mean Corpuscular Volume (MCV) (91.33 to 101.18), at the time of diagnosis and after six months of follow-up. On treatment of the patients with co-methyl (Cyanocobalamin) B12 injections a significant improvement in the mean values of Hb% (7.95 to 13.28), TC (3819 to 8652 cells/cumm), MCHC (32.17 to 33.43) and Vitamin B12 (125.68 to 311.81) along with decrease in the mean value of MCV (101.18 to 90.0) was noted. Conclusion: The most common fad diet followed by Gilbert’s syndrome patients is the restriction of high protein diet (mainly non vegetarian) and bland diet consumption leading to vitamin B12 deficiency and worsening jaundice. By taking thorough dietary history, considering cultural practices, one can tailor the therapy accordingly. A simple measure like dietary education and busting the myths can improve quality of life by accelerating recovery.

Keywords

• fad diet
• hyperbilirubinaemia
• megaloblastic anaemia